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Sheer terror and unbearable suffering has forced many civilians in Aleppo underground to escape the relentless aerial bombardment of opposition-held areas by Syrian regime forces, according to a new report published Tuesday by London based rights group, Amnesty International.

Death everywhere’: War crimes and human rights abuses in Aleppo details the horrendous war crimes and other abuses being committed in the city by regime forces and armed opposition groups on a daily basis, and concludes that some of the government’s actions in Aleppo amount to crimes against humanity.

The report paints a bleak and distressing picture of the devastation and bloodshed caused by barrel bombs - packed with explosives and metal fragments - which have been dropped by government forces on schools, hospitals, mosques and crowded markets.

Many hospitals and schools have sought safety by moving into basements or underground bunkers.

“Widespread atrocities, in particular the vicious and unrelenting aerial bombardment of civilian neighbourhoods by government forces, have made life for civilians in Aleppo increasingly unbearable. These reprehensible and continual strikes on residential areas point to a policy of deliberately and systematically targeting civilians in attacks that constitute war crimes and crimes against humanity,” said Philip Luther, Director of Amnesty International’s Middle East and North Africa Programme.

"By relentlessly and deliberately targeting civilians the Syrian government appears to have adopted a callous policy of collective punishment against the civilian population of Aleppo.”

Barrel bombs

Attacks using barrel bombs - oil barrels, fuel tanks or gas cylinders packed with explosives, fuel, and metal fragments dropped from helicopters - killed more than 3,000 civilians in Aleppo governorate last year, and more than 11,000 in Syria since 2012.

In April, local activists recorded at least 85 barrel bomb attacks in Aleppo city that killed at least 110 civilians. Yet the Syrian regime has failed to acknowledge a single civilian casualty caused by such attacks, with Bashar al-Assad categorically denying that barrel bombs had ever been used by his forces in a media interview in February 2015.

Survivors of the eight barrel bomb attacks documented in this report described harrowing scenes of carnage in the aftermath of the explosions making clear the true horror of these attacks.

A local surgeon said the level of injuries he had seen caused by barrel bombs was unprecedented: “Barrel bombs are the most horrible and hurtful weapon… [We deal with] multi-trauma, so many amputations, intestines out of the body, it’s too horrible,” he said.

One barrel bomb attack struck a crowded market in the Sukkari neighbourhood in June 2014 while 150 people were waiting in line to receive food baskets from a humanitarian distribution point nearby. An eyewitness described the aftermath of the attack as “pure horror”, saying the attack had targeted civilians:

“There was the man who ran the ice-cream shop, the man who ran the sandwich shop, the man who ran the toy store... They were all killed,” he said.

The report also details the terrifying ordeal for civilians living in the shadow of this deadly and persistent threat.

“There is no sun, no fresh air, we can’t go upstairs and there are always airplanes and helicopters in the sky,” said one doctor whose field hospital is among those forced underground.

Another resident described Aleppo as “the circle of hell”: “The streets are filled with blood. The people who have been killed are not the people who were fighting,” he said.

No impunity for perpetrators

Philip Luther of Amnesty sharply criticised what he said was as cold hearted indifference to the esclating human tragedy in Aleppo, and urged the global powers not to turn their back on the suffering before their eyes, adding that “continued inaction is being interpreted by perpetrators of war crimes and crimes against humanity as a sign they can continue to hold the civilians of Aleppo hostage without fear of any retribution.

"A referral of the situation in Syria to the International Criminal Court would send a signal that those ordering and committing these crimes can be brought to justice and could help stem the spiral of abuses,” said Luther.

In addition to barrel bombs, the report also documents three missile attacks by government forces including a devastating attack on a children’s art exhibition at Ain Jalut School in April 2014.

“I saw things there I can’t describe. There were parts of children, blood everywhere. The bodies were in shreds,” a geography teacher who witnessed the attack said.

Abuses by armed opposition groups

Armed opposition groups in Aleppo also committed war crimes by using imprecise weapons such as mortars and improvised rockets fitted with gas canisters called “hell cannons” in attacks that killed at least 600 civilians in 2014. Residents said attacks by armed opposition groups are often “completely random”. “You never feel secure or safe, ever. You never know – you could be hit at any time,” said one resident of al-Jamaliya neighbourhood.

Torture and other abuses

The report also documents widespread torture, arbitrary detention and abduction by both government forces and armed opposition groups.

One former detainee, a peaceful activist arrested by government forces in 2012 for videotaping a protest, described being forced into a car tyre, beaten with cables that cut into his skin and listening to the screams of others being tortured at night.

“Around 5 to 6am, you could hear only the women scream. At 7am, the women stopped, and then you heard the men. The screaming was scheduled,” he said. He was held at Aleppo Central Prison which was shelled by both sides and where hundreds of prisoners were starved and some were summarily executed.

A man held by an armed opposition group in Aleppo described having been severely beaten, given electric shocks and hung from his wrists for extended periods before eventually being released.

Humanitarian access

In addition to enduring brutal attacks from both sides, the people of Aleppo are living in dire conditions and struggle to obtain the most basic supplies including food, medicine, water and electricity.

In opposition-held areas food is extremely expensive and residents have resorted to planting their own vegetables as well as rearing rabbits and cats which have become the “fast food in Aleppo”, according to one resident.

Amnesty is calling on all sides to allow unhindered humanitarian access to agencies delivering aid in Aleppo and across Syria.